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Advanced Anesthesia > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Ductus venosus

A

Umbilical vein to IVC (bypassing liver)

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1
Q

Ductus Arterios

A

Aorta to pulmonary artery

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2
Q

Umbilical arteries (2)-

A

carries deoxygenated blood from fetus back to mother

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3
Q

Umbilical vein

A

carries oxygenated blood

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4
Q

CO dependent on HR

A

does not tolerate bradycardia
SV fixed

always have glyco/atropine

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5
Q

The baroreceptor reflex is not completely developed

A

Limiting ability to compensate for hypotension with reflex tachycardia

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6
Q

Autonomic innervation of the neonatal heart is predominately controlled by the

A

parasympathetic nervous system

Bradycardia with minor interventions (suctioning/DL)

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7
Q

total body water of preterm infant

A

80%

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8
Q

total body water of term infant

A

70

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9
Q

total body water of 6m-1y

A

60

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10
Q

VOD

A

Vd = Dose / plasma concentration of drug

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11
Q

Loading dose =

A

Vd x ( desired plasma concentration/bioavailability)

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12
Q

Acidic drugs are favortable absorbed where?

A

stomach (Non-ionized)

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13
Q

Basic drugs are best absorbed where?

A

alkaline intestines
(most oral drugs)
Slower in neonates and young children-delayed gastric emptying

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14
Q

Time in weeks between the first day of the last menstrual period and the day of delivery (weeks).

A

Gestational age

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15
Q

Time that has elapsed since birth (days, weeks, months or years)

A

Chronological Age

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16
Q

Gestational age + chronological age (weeks)

A

Post Menstrual Age

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17
Q

At what age does a baby need to stay overnight for apnea monitoring?

A

60 weeks post gestational age or PMA

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18
Q

Chronological age is reduced by the number of weeks born before 40 weeks of gestation (weeks, months).

A

Corrected Age

dictates mile stones

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19
Q

pvr in utero

A

elevated

Diverts a majority of RV output to the descending aorta via ductus arteriosus.

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20
Q

describe Transitional Circulation

A

Lungs: fluid is replaced by air (raising alveolar O2 tension) and fluid is resorbed
↓ PVR

Hypoxic vasoconstriction in lungs reverses

↑ flow of blood in lungs → Path of least resistance
↑ blood return to LA (↑ pressure)-PFO closes (closes pop off)
↑ flow out LVOT, DA senses ↑ pO2, PGE from placenta ↓ & DA closes

PGE keeps DA open during transposition, HLHS

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21
Q

Persistent Pulmonary Hypertension of the Newborn

A

PDO / PDA might not close because of high right-sided pressure

Rapid desaturation: FiO2 won’t help → Phenylephrine and Nitric Oxide

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22
Q

Managing PPHN

A

O2, correct acidosis, normothermia, nitric oxide, surfactant, HFV, remodulin, sildenafil, milrinone, bosentan

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23
Q

Can peds patients adjust their SV?

A

no. SV fixed, CO is dependent on HR

CO = HR x SV

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24
Q

baroreceptor is not developed

A

Limiting ability to compensate for hypotension with reflex tachycardia

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25
Q

fetal hemoglobin causes a what shift?

A

left (love) 19 vs 27

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26
Q

when is physiologic nadir of hgb

A

3-4 months

27
Q

what Clotting factors are 20-50% of adult levels?

A

2, 7, 9, 10

28
Q

neonatal airway caviats

A

epiglottis longer/ narrower
Larynx anterior/cephalad/smaller
shorter neck
tongue/adenoids larger
telescopic subglottic area

29
Q

FRC in neonate

A

Lower

30
Q

diaphram in neonate

A

flat instead of dome

31
Q

metabolic rate / O2 consumption in neonate

A

increased

32
Q

Hypoglycemia can cause

A

apnea
hypotension
bradycardia
convulsions
brain injury

33
Q

Exposure to noxious stimuli/pain with inadequate or absent pain control can have physiologic consequences

A

→ Intraventicular Hemorrhage & PHTN

Lack of development of inhibitory tracts may increase the intensity and duration of painful stimuli

34
Q

when do fontanelles close

A

Anterior fontanelle closes at 2 years
Posterior fontanelle closes at 4 months

35
Q

most common heat loss

A

Radiant (majority): loss to environment (air)

cover head

36
Q

Neonate lacks ability to regulate body temperature due to

A

Large surface area
Lack of SQ tissues
Inability to shiver

37
Q

where to maintain sats to prevent ROP?

A

O2 sats- 92-98%

atropine increases IOP –> use glyco

38
Q

All infants less than how many PCA should be monitored

A

<62 weeks PCA

39
Q

coarctation high BP

A

Coarc: high BP on L upper extremity

40
Q

NPO status
Current recommendations from ASA

A

2: clear liquids
4: breast milk
6: formula, fortified breast milk
8: solids

41
Q

Size of ETT

A

2 & up: Uncuffed
(age in years/4) + 4
or
(Age +16)/4

Cuffed to cuffed drop ½ size
Leak desirable between 15-25 cm H2O

42
Q

Depth of ETT:

A

3x ID of ETT
Nasal + 1-1.5cm

Uncuffed ETT have double black line (place at VC)

43
Q

preterm baby ETT and Miller

A

ETT 2.0 - 3.0
Miller 0

44
Q

full term ETT

A

ETT 3-3.5
Miller 1 - WIS 1.5

45
Q

3mo - 1 year ETT

A

ETT 4.0
Miller 1 - WIS 1.5 or
WIS 1.5 - Miller 2

46
Q

po dose of midazolam

A

Midazolam (0.25-1 mg/kg PO)​

47
Q

IM & PO dose ketamine

A

Ketamine (6 mg/kg PO)

48
Q

IN dose dexmede

A

Dexmedetomidine (2mcg/kg IN)

49
Q

dose of succinylcholine

A

2mg/kg

50
Q

Atropine

A

0.02 mg/kg

51
Q

epi dose

A

0.01mg/kg

52
Q

propofol induction dose

A

2.5-3.5 mg/kg

53
Q

why are peds sensitive to NDMB?

A

Low levels of Ach at the motor nerves but counterbalanced by increased VOD.

Increased dosing of Sux d/t large VOD.

54
Q

Intravenous Induction indications

A

full stomach
hx GERD
disease state (illness)

55
Q

what is emla ?

A

2.5% lido/prilocaine
apply 30-60 m

56
Q

emla risk?

A

methemoglobinemia (rare side effect of prilocaine toxicity)

57
Q

Methemoglobinemia review

A

S/S: hypoxia, cyanosis, tachycardia, tachypnea,

Benzocaine >300mg, prilocaine, cetacaine, ELMA

decreased O2 carrying capacity by changing the binding of O2 to hemoglobin

Left shift

Pulse ox will be 85% with a normal PaO2 75-100

> 70: dialysis and exchange transfusion

Methylene Blue: 1-2 mg/kg over 5-10min

58
Q

MAC _____ in neonatal period & ____ in infants (1-6m)

A

lower; highest

59
Q

Adverse respiratory events with Iso/Des:

A

breath holding
laryngospasm
coughing
increased secretions

60
Q

Reversal

A

0.05 mg/kg of Neostigmine (same as adults)
0.02 mg/kg Atropine
0.01 mg/kg Glyco

61
Q

BRIDION® (sugammadex) is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults and pediatric patients aged

A

2 years and older undergoing surgery

62
Q

sugammadex dose in peds

A

2 mg/kg

intentionally avoided in males and teenagers

63
Q

Laryngospasm

A

PPV
Succ (4mg/kg) and Atropine IM ( 0.02 mg/kg, with a maximum dose of 0.5 mg)

64
Q
A

Advanced Anesthesia (8 decks)

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